摘要:
[Objective]To observe the efficacy of telbivudine combined with marine capsules on hepatitis B cirrhosis patients and the effects on hepatic fibrosis. [Methods]From Aug 2014 to Dec 2015, 126 patients with hepatitis B cirrhosis in our hospital were randomly divided into treatment group and control group. Telbivudine monotherapy for the control group, telbivudine combined with marine capsules as the treatment group, with 63 cases in each group. The two groups were given routine symptomatic treatment. The differences of liver function(ALT, AST), liver stiffness, liver fibrosis indexes(HA, LN, PC Ⅲ, C IV)before and after treatment were compared between the two groups, and the serum levels of HBV-DNA and HBeAg were compared 48 weeks after the treatment. The t-test was used for the comparison of continuous data between the groups, and the chi-square test was used for the comparison of the categorical data between the groups. [Results]There was no significant difference between the two groups of liver function, liver stiffness and liver fibrosis index before treatment(P>0.05). The negative conversion rate of HBVDNA(43/63, 68.3%)in treatment group was higher than that of control group(32/63, 50.8%)48 weeks after the treatment(P<0.05). During the same period, there was no significant difference between the two groups(20.6%, 15.9%) on the negative conversion rate of HBeAg(P>0.05). And the treatment group showed significant reductions in serum collagen type IV, procollagen type Ⅲ, laminin, hyaluronic acid, alanine aminotransferase(ALT), aspartate aminotransferase (AST), liver stiffness after the treatment (P<0.05). [Conclusion]Telbivudine combined with marine capsules have better effect in liver function and serum liver fibrosis indexes. Its antiviral ability is strong, and can improve the prognosis of patients with hepatitis B cirrhosis.%[目的]研究高病毒载量乙肝肝硬化代偿期患者应用替诺福韦酯联合苦参素胶囊的抗病毒疗效及对肝纤维化指标改善的情况.[方法]选取入院行常规对症治疗的高病毒载量乙肝肝硬化代偿期患者126例作为研究对象,随机分为治疗组(替诺福韦酯联合苦参素胶囊治疗)和对照组(单用替诺福韦酯治疗),每组各63例.比较2组患者治疗前后肝功能指标(ALT、AST)、肝脏硬度值(LSM)、肝纤维化血清学指标(HA、LN、PC Ⅲ、C Ⅳ)的差异及治疗48周时血清HBV-DNA阴转率、HBeAg阴转率.[结果]治疗组与对照组患者在治疗前肝功能指标、肝纤维化血清学指标及LSM比较均差异无统计学意义(P>0.05);治疗48周后,治疗组的HBV-DNA阴转率(43/63,68.3%)高于对照组(32/63,50.8%),2组比较差异有统计学意义(P<0.05);同期治疗组、对照组HBeAg阴转率(20.6%、15.9%)相比,差异无统计学意义(P>0.05).治疗48周后,治疗组ALT、AST、HA、LN、PC Ⅲ、C Ⅳ及LSM水平较对照组均明显下降,2组比较均差异有统计学意义(P<0.05~0.01).[结论]替诺福韦酯联合苦参素胶囊可较好地改善乙肝肝硬化患者的肝纤维化程度,提高抗病毒疗效,显著地改善患者预后.